The relationship between cleaning product exposure and respiratory and skin symptoms among healthcare workers in a hospital setting: A systematic review and meta-analysis.

Background and Aims: Several studies from multiple work settings have reported an increase in asthma and asthma-like respiratory symptoms in workers exposed to cleaning or disinfecting agents. Hospital workers perform many cleaning and disinfecting activities and may be vulnerable to respiratory and skin symptoms caused by these agents. This systematic review and meta-analysis aim to quantify the risk of asthma and asthma-like symptoms in hospital workers exposed to cleaning/disinfecting agents. A secondary aim is to assess associated risks of skin symptoms in those studies. Methods: MEDLINE, EMBASE, CDSR, CENTRAL, CINAHL databases, and references of relevant review articles were searched. NHLBI quality assessment tools were used to assess the quality of the included studies. A total of 2550 articles were retrieved and 34 studies met criteria to be included. The software R version 4.0.5 was used to perform the meta-analysis. The random-effects model was used to pool the results due to within-studies heterogeneity. Results: Meta-analysis of 10 studies evaluating the association between occupational cleaning exposures and asthma demonstrated a 35% increased risk in exposed hospital workers (meta-RR = 1.35, 95% CI: 1.09-1.68). The risk of asthma increased when workers were exposed to bleach compared with nonexposed workers (meta-RR = 1.51, 95% CI: 0.54-4.18), but was not statistically significant. Two studies investigated the relationship between respiratory and skin symptoms and produced mixed results. Conclusions: The results suggest a need for preventive practices to reduce the risk of asthma and asthma-like symptoms in hospital workers exposed to occupational cleaning/disinfecting agents. Trial registration number: CRD42020137804.

Cleaning agent usage in healthcare professionals and relationship to lung and skin symptoms.

BACKGROUND AND OBJECTIVES: Healthcare workers have an increased risk of respiratory symptoms and dermatitis, likely related to cleaning/disinfecting agents. The aim of this study was to identify work tasks and cleaning/disinfecting agents associated with respiratory symptoms and hand dermatitis among healthcare workers in a tertiary hospital. METHODS: Cleaning agent usage, respiratory symptoms and skin symptoms were recorded by participants using a questionnaire in a cross-sectional study. Age and sex adjusted odds ratios (OR) were used to examine associations between job tasks, exposures, respiratory, and skin outcomes. RESULTS: Two hundred and thirty healthcare workers who were exposed to cleaning agents were compared with 77 who had no, or minimal, exposure. Exposed workers had an increased risk of respiratory symptoms (adjusted OR = 2.17; 95% CI: 1.18-4.14) and skin symptoms (adjusted OR = 1.77; 95% CI: 1.00 - 3.17). Washing instruments manually, using aerosol products, cleaning operating rooms, cleaning sanitary rooms, preparing disinfectants, and filling devices with cleaning products were cleaning tasks associated with various respiratory symptoms. Bleach was the only cleaning agent associated with a respiratory symptom: tightness in the chest (unadjusted OR = 2.46; 95% CI: 1.01-6.89) but statistical significance did not persist after adjustment for age and sex. Hand dermatitis was associated with actual disinfecting tasks (adjusted OR = 2.19; 95% CI: 1.10-4.66). Bleach was the only cleaning agent significantly associated with hand dermatitis (adjusted OR = 2.54; 95% CI: 1.32-5.13). CONCLUSIONS: This study provides insight into possible work tasks that need interventions to reduce or prevent respiratory and skin symptoms in healthcare workers.

Comparison of Psychological, Quality of Life, Work-Limitation, and Socioeconomic Status Between Patients With Occupational Asthma and Work-Exacerbated Asthma.

OBJECTIVE: The aim of this study was to compare psychological status, quality of life (QoL), work limitation, and socioeconomic status between patients with occupational asthma (OA) and work-exacerbated asthma (WEA). METHODS: The following questionnaires were administered to participants: Beck anxiety and depression (II) inventories, Marks' Asthma Quality of Life Questionnaire, and Work Limitations Questionnaire. Cross-sectional analyses between OA and WEA subgroups were completed. RESULTS: There were 77 participants. WEA subjects had a trend to higher anxiety scores (OA = 9.2 ±â€Š8.0, WEA = 12.8 ±â€Š8.3, P = 0.07, Cohen d = 0.4). Depression scores trended higher for those with WEA (OA = 9.6 ±â€Š10.3, WEA = 13.4 ±â€Š13.5, P = 0.2, Cohen d = 0.3). QoL was comparable between groups. WEA subjects had fewer work limitations (N = 50, OA = 25.1 ±â€Š27.3, WEA = 20.6 ±â€Š24.4, P = 0.56, Cohen d = 0.3) and OA subjects were more likely to have reduced income. CONCLUSION: In a tertiary clinic, there were some modest differences for specific variables between OA and WEA subjects that may help inform management.

Trends in Occupations and Work Sectors Among Patients With Work-Related Asthma at a Canadian Tertiary Care Clinic.

BACKGROUND: Work-related asthma (WRA) is the most common chronic occupational lung disease in the developed world. Several factors including sociodemographic status and occupation/industry increase the risks of developing WRA. In this study, we sought to identify changes in patterns and characteristics among patients with WRA over a 15-year period in an occupational lung disease clinic. METHODS: We performed a retrospective analysis of patients with WRA charts at the Occupational Lung Disease Clinic of a University Hospital in Toronto, Canada. Patients were divided into two periods classified by first attendance at the clinic 2000 through 2007 and 2008 through 2015. Comparisons between the two periods included: sociodemographic characteristics, smoking status, occupations, exposures, and submitted workers' compensation claims. RESULTS: Fewer occupational asthma cases were seen in the more recent period vs the earlier period (40 vs 74 cases), with a smaller reduction in work-exacerbated asthma cases (40 vs 58). The recent period included a significantly smaller proportion employed in the manufacturing industry and isocyanate-induced cases compared with the earlier period. An increased proportion were employed in health-care and education industries (primarily cleaners and teachers) in the recent period, consistent with a corresponding increased frequency of cleaning agents and dust exposures. CONCLUSIONS: The changes observed in work sectors in the patients with WRA in this clinic in Toronto are consistent with reductions reported in Ontario workers' compensation claims for occupational asthma and may relate to preventive measures. Cleaners and teachers should be a focus of further intervention measures for work-related asthma.

Evaluation of the efficacy of a web-based work-related asthma educational tool.

BACKGROUND: Work-related asthma (WRA) has been estimated to account for 15-20% of adult asthma cases. Studies have indicated that a substantial number of asthma patients have inadequate knowledge of work-related effects on their disease, which may contribute to suboptimal asthma control. A Canadian web-based educational tool on WRA was developed to address this knowledge gap in the population. OBJECTIVE: To evaluate the effectiveness of this web-based tool. METHODS: Participants were recruited prior to a routine visit at a tertiary care asthma clinic in Toronto. A brief WRA knowledge questionnaire was developed and administered immediately before and after using of the web-based educational tool, and one year later. RESULTS: The study sample (N = 34) was mostly female (68%) with a mean age of 50.7 (SD, 17.2). Participants demonstrated significant improvement in questionnaire scores following interaction with the tool. The mean score increased from 76% (SEM = 2.1) to 84% (SEM = 1.7) (p = 0.001). On average, scores improved on 12 of the 13 questionnaire items. A 1-year follow-up of a sample of 19 participants demonstrated a slight reduction in mean scores, from 86% (SEM = 1.9) to 84% (SEM = 1.9), but still demonstrated a trend towards a higher score than the baseline (78%; SEM = 2.9; p = 0.08). CONCLUSIONS: Our findings suggest that the educational tool has a positive effect on WRA knowledge, and that knowledge may be retained long-term. Future studies are needed in non-tertiary care clinic populations which may possess less baseline knowledge of WRA.